PVOTRN Donor Information Form

Fields with (*) are required. Note that this information is just for the records of PVOTRN. After submission of this form you will be directed on the next page to PayPal's secure donation processing system to complete your donation.

First Name*

Last Name*

Email Address*

Address Line 1

Address Line 2

City

State or Province

Zipcode

Phone

Church You Attend?

Do you want to remain Anonymous?

Yes, I want to remain Anonymous.
No, List me as a donor on the website.

Type of Donation*
(Choose only one)

One Time
Automatic Monthly
Day Sponsor ($20.00)

Amount of Donation

If you chose Day Sponsor above, please provide the date you would like to sponsor as well as a second choice. The date are first come first serve and you will be notified if the dates you choose are available.

Sponsoring Date If Available

Sponsoring Date Second Choice

This section is not required unless you would like to honor or remember someone on the day you selected.

In Memory Of
In Honor Of

In Honor/Memory Name

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